How Neighborhood Social Needs Drive Diabetes Care Disparities

Patients with type 2 diabetes who live in neighborhoods with higher social needs are more likely to rely on emergency care, receive less routine preventive care, and experience more complications than those living in communities with fewer social needs.¹

These findings were published in Vizient’s CMS Qualified Entity Program report, which looked at diabetes care and outcomes across individual patients and their communities between 2018 and 2022. Through the Qualified Entry Program, Vizient could access 100% of Medicare claims data across the US.

The increasing prevalence of diabetes in the US poses a major challenge for both the health care system and patients. According to the CDC, an estimated 11.6% of the population (38.4 million people) has either type 1 or type 2 diabetes, while 38% (97.6 million people) are living with prediabetes.²

Unmet social needs in certain neighborhoods contribute to disparities in diabetes care | Image credit: trekandphoto – stock.adobe.com

The report used the Vizient Vulnerability Index (VVI) to assess how social factors—like access to housing, food, education, transportation, and health care—impact diabetes care in different neighborhoods.¹ By grouping areas based on their level of social need, the VVI helped identify disparities in essential care, such as the frequency of diabetic eye exams. According to the report, this approach allows health care providers to better understand where gaps exist in care delivery and use the data to target improvements in diabetes outcomes more effectively.

“When providers have the insights that highlight disparities among their patient populations, they can tailor interventions to the specific needs of their patients,” said Madeleine McDowell, MD, senior principal of intelligence at Vizient.³ “Early diagnosis and management by a primary care physician is critical to the disease trajectory of type 2 diabetes.”

Acute Care Utilization

Among adults aged 18 to 50 with diabetes, the rate of emergency department (ED) visits was twice as high for those in areas with high social needs than those with low social needs.¹ Regardless of age, patients living in areas with greater social needs used ED and inpatient services more frequently, but the biggest difference was seen among adults aged younger than 50. Younger patients also relied more heavily on emergency services and hospital admissions than older adults across both commercial insurance and Medicare populations.

The data also revealed stark differences based on payer type. Patients on Medicaid saw the largest gap in acute care use between high– and low-need neighborhoods, reflecting the challenges these patients face in accessing routine care. Similarly, Medicare patients under 65—often individuals with disabilities—exhibited patterns of acute care use similar to those on Medicaid, further underscoring the impact of unmet social needs on health outcomes.

Diabetes Screening and Prevention

The report revealed key trends in how preventive services are used by people with type 2 diabetes, showing that access to primary care and routine screening varies based on age, insurance type, and social factors. For Medicare patients, regular visits to primary care providers (PCPs) were closely linked with higher rates of diabetes screenings. Prevention efforts—such as counseling on smoking cessation, healthy eating, and physical activity—were more commonly utilized by younger patients across all insurance types, reflecting an emphasis on lifestyle interventions in early adulthood.

Social needs also influence the use of preventive services. Patients in neighborhoods with the highest social needs were more likely to engage in diabetes prevention activities, with younger adults under 60 leading in participation. However, middle-aged adults in these high-need areas also had higher screening rates compared with those in more resource-rich neighborhoods. Interestingly, patients on Medicaid showed a reverse trend, with higher rates of preventive service use in low-need areas, suggesting that other barriers may impact preventive care in socially vulnerable neighborhoods.

Impact on Diabetes Outcomes

Troubling trends were seen in diabetes complications, with younger patients on Medicare experiencing surprisingly high rates of severe outcomes. In some cases, complications like kidney and circulatory issues in the youngest Medicare group were comparable to those seen in patients in their 80s.

Patients living in neighborhoods with the highest social needs were more likely to experience severe complications, including insulin resistance, kidney, neurological, and skin issues. These disparities were particularly pronounced in middle-aged adults for neurological and skin complications, while those younger than 60 in high-need areas had the largest gaps in insulin resistance rates compared with those in lower-need areas. Across commercial and Medicaid populations, insulin dependence tended to decline with age, while complications related to circulation, kidneys, nerves, and skin increase as patients grow older.

Data also underscored the importance of early intervention. Patients who visited a PCP within 12 months of their diabetes diagnosis were more likely to avoid complications and remain off insulin after 5 years compared with those who did not see a PCP. Specifically, patients in their 30s who did not visit their PCP within a year had a 5.4% higher complication rate than those who did—the largest age-based gap compared with the 2.5% difference seen in adults in their 80s who did or did not see a PCP.

References

1. Vizient. Measuring type-2 diabetes care and outcomes across patients and their communities. August 3, 2024. Accessed October 18, 2024. https://vizientinc-delivery.sitecorecontenthub.cloud/api/public/content/6a2cbabd56684a4a9558cbb06273ad5f
2. National diabetes statistics report. CDC. Accessed October 18, 2024. https://www.cdc.gov/diabetes/php/data-research/index.html
3. Vizient report links care disparities for type 2 diabetes patients in neighborhoods with high social needs. News release. Vizient. October 2, 2024. Accessed October 18, 2024. https://www.businesswire.com/news/home/20241002990833/en/Vizient-Report-Links-Care-Disparities-for-Type-2-Diabetes-Patients-in-Neighborhoods-With-High-Social-Needs